Tag Archives: AHRQ

Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

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Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care, Uncategorized

Splashy Statisticians in Spotlight at ACC ’09

 

photo by Bruce Jancin

photo by Bruce Jancin

From the annual scientific assembly of the American College of Cardiology, Orlando

Many of the biggest ooh’s and ah’s at this meeting were directed not at new blockbuster megatrial findings–those were in limited supply–but rather at groundbreaking study methodologies so dazzling even nonstatisticians were awed. It’s been a rare chance for the statisticians to take center stage and accept accolades for their work, the most extraordinary of which was hailed as “robust”–among the highest possible praise in the typically understated medical lexicon.

A case in point drawn from interventional cardiology: A comparison of 3-year clinical outcomes of drug-eluting and bare metal stents in 262,700 (!) Medicare patients, far and away the largest-ever stent study. This behemoth, commissioned by the FDA and Agency for Healthcare Research and Quality, was accomplished by heroically linking the ACC’s National Cardiovascular Data Registry with the Medicare patient database.

Most remarkably, the investigators sidestepped insurmountable confidentiality issues by tracking outcomes without any access to patient names or other individual identifiers. How did they do it? By coupling birthdates and other indirect identifiers with super-sophisticated clustering methods reliant upon inverse probability weighted estimators incorporating 102 covariates.

Statistical bling was also in evidence on the surgical side, most notably in the 1,000-patient Surgical Treatment for Ischemic Heart Failure (STICH) study, the largest-ever randomized trial comparing two surgical strategies. Its partisans hope STICH’s clear findings will help convince surgeons to move beyond their traditional reliance on anecdotal evidence and case series into the modern era of comparative effectiveness research.

—Bruce Jancin
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Filed under Cardiovascular Medicine